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63rd Annual OTR Conference

Ponte Vedra Beach, FL

Join us February 21-24, 2018

June 26, 2017 - Weekly Legislative Update

The Senate Republicans are rolling out their proposal to repeal and replace the Affordable Care Act (ACA).

As predicted, the proposal differs significantly in a number of respects from the bill that the House passed in May.

We are still reviewing the details of the proposal and determining the implications for TIA and its members. In the meantime, we wanted to share with you the attached helpful side by side comparison of how the House bill and the Senate proposal would handle key portions of the ACA.

ACA

HOUSE BILL

SENATE BILL

The individual mandate requires most Americans to have health coverage or pay a fine.

Instead of the mandate, insurers would be allowed to impose a 30 percent premium surcharge on consumers who purchase a new plan after letting their previous coverage lapse - incentivizing healthy people to remain insured. States could choose to make this penalty more severe.

The individual mandate would be eliminated. Nothing would replace it to incentivize healthy people to get insurance.

The employer mandate requires larger companies to offer affordable coverage to their employees.

The employer mandate would be eliminated.

The employer mandate would be eliminated.

Young adults could stay on their parents' health insurance plan until they're 26 years old.

This provision was unchanged.

This provision was unchanged.

How they would pay for coverage

The federal health insurance subsidies that help most people with ACA marketplace plans afford their coverage would change. Health care would get substantially less affordable for most of these people, especially those who are poor, unhealthy or old, according to Linda Blumberg of the Urban Institute, Christine Eibner of Rand Corp. and Karen Pollitz of the Kaiser Family Foundation.

ACA

HOUSE BILL

SENATE BILL

ACA tax credits are primarily based on income, age and geography, which benefits lower- and moderate-income people buying coverage through ACA marketplaces.

Tax credits would be based primarily on age. The amount would not increase when premiums increased, and people living in higher-cost areas would receive no additional money.

Tax credits would be primarily based on age, income and geography. But they would be made to cover a skimpier plan, and people would need to be lower-income than under the ACA to receive them.

Cost-sharing subsidies were provided to insurers to help some of their ACA customers cover deductibles and co-payments.

These subsidies would end in 2020, although Trump could cut them off earlier.

These subsidies would end in 2020, although Trump could cut them off earlier.

Insurance companies are not allowed to increase someone's premiums or deny coverage based on preexisting conditions.

States could allow insurers to increase someone's premiums based on their preexisting conditions if they had a break in coverage. The state would have to set up some other program, such as a high-risk pool, to cover its sickest residents. And the federal government would have its own $8 billion fund to help cover sick people's high premiums within the individual market.

Insurance companies are not allowed to increase someone's premiums or deny coverage based on preexisting conditions, though states may allow them to not cover costs associated with some conditions.

Insurers can charge older customers up to three times as much as they charge younger customers.

Insurers would be able to charge older customers up to five timesas much as they charge younger customers. States could change this ratio, although it's unclear whether it could be higher than 5 to 1.

Insurers would be able to charge older customers up to five times as much as they charge younger customers.

Individuals can contribute up to $3,400 and families up to $6,750 to pretax health savings accounts.

Starting in 2018, individuals could contribute up to $6,550 and families could contribute up to $13,100 to pretax health savings accounts.

People can contribute more to their health savings accounts than under the ACA.

The ACA did not create high-risk pools, because there were other protections for pre-existing conditions.

States would receive $130 billion over 10 years through a new Patient and State Stability Fund for high-risk pools and other programs to help sicker people.

The stability fund would receive $112 billion over 10 years and would be aimed at reimbursing insurers who take big losses.

Proposed changes to Medicaid

The bill would restructure Medicaid, narrow the program's eligibility and probably decrease its funding.

ACA

HOUSE BILL

SENATE BILL

Medicaid is an entitlement program with open-ended, matching federal funds for anyone who qualifies.

Medicaid would be funded by giving states a per capita amount or block grant based on how much each state is spending, not adjusting for rising costs. Overall, this is expected to substantially decrease federal funding, according to the Congressional Budget Office's report on the plan.

Medicaid would be funded by giving states a per capita amount or block grant, beginning in 2021. The amount would grow more slowly than in the House bill, meaning bigger spending cuts overall.

States can expand Medicaid to cover people making up to 138 percent of the poverty line, and the federal government would cover an outsize portion of their costs.

States would not be able to expand Medicaid after this year. In states that do expand by the deadline, the federal government will pay a smaller portion of the cost for people who sign up after 2019, making the expansion much more expensive for those states.

For states that expand Medicaid, the federal government would pay a smaller portion of the cost starting in 2021.

Other key elements of the plans

ACA

HOUSE BILL

SENATE BILL

Insurers are required to cover certain categories of essential health benefits, such as hospital visits and mental-health care.

States would be allowed to change what qualifies as an essential health benefit.

States would be allowed to change what qualifies as an essential health benefit.